GRASSROOTS: The GMT Initiative Blog

Grassroots reports on the work of amfAR-supported research teams and advocates responding to the devastating impact of HIV among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

GMT Initiative Director Kent Klindera (fourth from right) meets with members of the Health and Opportunity Network (HON) in Pattaya, Thailand.

I just finished up a week of meeting with various organizations and individuals involved in the trans* health and rights movement in Thailand. It was a bit of a homecoming for me, as over 20 years ago I lived as a Peace Corps volunteer in rural Northeastern Thailand for four years. Back then, trans women where accepted in small towns and villages. They often assumed societal roles typically ascribed to women (e.g., beauticians, seamstresses, nurses, etc.). However, while they appeared to be tolerated within society, this tolerance was only on the surface. They often were the brunt of jokes and were highly stigmatized and discriminated against in educational and employment settings.

A condom dress that will be modeled in December during HON’s annual World AIDS Day fashion show. Sadly, 20 years on, not much has changed in Thailand. The women continue to face pervasive stigma and discrimination—which often fuels HIV risk behavior. Newly emerging epidemiological data indicate HIV rates among trans women are much higher than among the general population. They also have biological risk factors that contribute to this rate, based on anal sexual behavior that is 19 times more likely to transmit HIV than vaginal intercourse. Because of the stigma, very few health services exist that are appropriate for trans individuals, which deters many women from seeking out HIV care and testing and other services.

However, during my visit, I saw signs that progress is being made. I met up with a current GMT Initiative grantee, the Health and Opportunity Network (HON), based in Pattaya, about two hours Southeast of Bangkok. The HON focuses on the health and social needs of sex workers, including trans sex workers. They offer social support, a trans friendly health center, and vocational and academic training opportunities. With amfAR support, they are now implementing activities to advocate for the Thai government’s public health and social service system to offer more trans-appropriate services. They hope that soon the Thai government will be supporting them in their community-run efforts.

I also met with many other activists to gain clarity on the best way amfAR could invest additional funds into achieving policy reform to decrease HIV vulnerabilities for this population. Almost everyone I talked to discussed the legal challenges of gender reassignment, including that not being able to legally change one’s gender was a huge challenge—and a contributing factor in why trans women are not seeking HIV services, as they are not treated with appropriate services for their gender identity.

amfAR’s Noweed Charles (center) talks with members of HON.

I was most impressed with the Thai Transgender Alliance’s efforts to use sociological research to guide their advocacy efforts. They had just come off of a major victory working with the Thai military to end a discriminatory conscription policy that labeled trans women as “mentally unstable” because they were unable to serve in the military. This label went into the permanent records of these individuals, which inhibited many from gaining meaningful employment and educational opportunities.

I witnessed a trans movement set to achieve even greater policy goals, and I leave Thailand with much greater insight and hope about trans health and human rights issues. I’m so excited amfAR is a part of this effort, as we work to eventually impact the HIV rates among this vulnerable population.

* The terms ‘trans’ is used as an umbrella term, grouping together a variety of people with different identities who don’t really fit within their society's standards of how women and men are supposed to look and act (in other words, they're "gender non-conforming").

In September, Pope
Francis made global headlines when he stated that the Catholic Church had grown
“obsessed” with gay rights, contraception, and abortion, and called for it to
“find a new balance.” The majority of the world’s 1.2 billion Catholics now
reside in Africa, the Caribbean, Latin America, and Asia—many in the countries
hardest hit by the AIDS epidemic. And the Catholic Church is also the largest
private provider of HIV care in the world. However, until 2010, 30 years into the
epidemic, the church condemned the use of condoms in any circumstance,
including for the prevention of HIV. And the Holy See did not publicly speak out
against homophobic violence and anti-gay laws until 2008.

But while Francis’
September statement was a momentous and high profile shift for church, it was
far from an isolated event. Church officials have been increasingly using the
pulpit to advocate for sound HIV policies for all populations in their
communities for years. amfAR spoke to Craig Rijkaard, acting executive director of the
Antiguan Resilience Collective Inc. (ARC)—a GMT Initiative grantee partner—about
how the Catholic Church in Antigua and Barbuda’s efforts to combat HIV and the
anti-gay policies that fuel new infections have impacted his organization’s HIV
outreach and advocacy work.

Craig Rijkaard, executive director of the Antiguan Resilience Collective Inc., visit’s amfAR’s New York offices. Even before Pope Francis spoke, back in Benedict’s time, we
got a new bishop in Antigua, Bishop Kenneth Richards, who within I think the first month after he got ordained went on
the radio and said publicly that he is not to judge what happens in an adult
bedroom. And that got the ball rolling. Now we have a lot of discussion
surrounding this issue on talk shows and in the churches. Some churches are now
inviting people from different organizations and from the Directorate of Gender
Affairs to come in and talk to their congregations about it.

Men who have sex with men (MSM) are criminalized in Antigua
and Barbuda, and that can make it very difficult for them to access health
services. In the churches, they talk about gay rights in terms of HIV. They say
that everybody has the right to healthcare and that we need to make access easy
for everyone, because if it’s not, it means the faithful housewife could be
infected by her husband, who maybe goes out sleeping with a sex worker, be it
male or female.

At ARC, we provide trainings for healthcare workers and a
referral system so GMT can see a doctor who won’t treat them differently, and we’ve
been invited to talk on the air about these programs to ensure that people in
same-sex relationships have the same access to health services as everyone
else. Currently, an individual might go to the public health service and say
they have MSM-related health issues, and first they have to tell the person at
the counter, and then then nurse, and then the doctor, and they may experience
stigma or discrimination. So we find that a lot of clients end up
self-medicating and aren’t getting the care they need.

We are not at a place where everyone is going to say, oh yes,
we totally accept homosexuals and lesbians, but we’ve seen a shift in how people
have been behaving recently, since all the discussions. In the past, we had bad
situations where homosexuals were stoned or beaten, and they couldn’t go
certain places, and now we are seeing it’s more normal. I think this has made
the healthcare workers more receptive. Recently, I met with a head nurse about
doing a workshop to help the community nurses provide better care for MSM and
she said, ‘Just let me know when you want to have the workshop and how many
nurses you need and how we can work with you.’